Altered Peripheral Tissue Perfusion

 

Instructions: Fill out this form, print it, and hand it in with your assessment to your instructor. When you click on Next at the bottom of the page, you see the data you submitted. Please follow the instructions on how to save the data on the next page.

AOL users: Read this instruction.

Definition: a decrease in oxygen resulting in failure to nourish the tissues at the capillary level

1. Your initials (required): 

2. Defining Characteristics- check those that apply to your client:

None- high risk diagnosis  altered sensation  altered skin characteristics (thickened nails, decreased hair, cool)  claudication  delayed healing  diminished pulses  edema  positive Homan's sign 

3. Related Factors- check those that apply to your client:

interruption of arterial flow  interruption of venous flow hypovolemia immobility  dehydration 
mechanical or treatment related obstruction of blood flow  trauma  medications


4. Goal (ultimate, long term) 

5. Outcome Criteria (short term) 

6. Evaluation: Was the outcome criteria met? 

Yes- Give Evidence: 

No- Explain how you would change the plan: 

7A. Interventions 

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7B. Rationale for each intervention
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